Meier Erin, Pennington Kelly, Gallo de Moraes Alice, Escalante Patricio
American University of the Caribbean School of Medicine, USA.
Department of Medicine, Division of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Respir Med Case Rep. 2017 Jun 23;22:70-73. doi: 10.1016/j.rmcr.2017.06.012. eCollection 2017.
(MAC) is responsible for a large portion of non-tuberculous mycobacterial (NTM) infections worldwide. Host factors such as active malignancy, immunosuppression, chronic obstructive pulmonary disease (COPD) and bronchiectasis increase the risk of MAC infection. However, the relationship between previously treated lung cancer with subsequent development of MAC pulmonary disease and treatment outcomes have not been previously studied.
We retrospectively identified all patients with lung cancer and MAC pulmonary disease documented in medical records at Mayo Clinic between January 2005 and October 2016. Patients who were diagnosed with MAC pulmonary disease before or at the time of lung cancer diagnosis were excluded. Patients meeting all inclusion criteria underwent chart review for prior oncologic treatments, clinical characteristics, and MAC treatment response.
We identified 13 patients with MAC pulmonary disease and prior lung cancer, including 4 men and 9 women. Eight patients had structural lung disease that can predispose to MAC pulmonary disease, including bronchiectasis (23.0%) and COPD (46.2%). Four (30.8%) had no apparent immunosuppression or other risk factor(s) for MAC pulmonary disease. Primary pulmonary malignancies included pulmonary carcinoid, adenocarcinoma, and squamous cell carcinoma. Ten (76.9%) patients were started on antimicrobial treatment for MAC, and 8 (61.5%) patients completed MAC treatment with 6 (46.1%) patients achieving symptomatic improvement.
MAC pulmonary disease in previously treated lung cancer can occur without apparent risk factors for this NTM infection. Symptomatic improvement with MAC antimicrobial therapy appears to be lower than expected but comorbidities might influence outcomes in this patient population.
鸟分枝杆菌复合群（MAC）在全球范围内导致了很大一部分非结核分枝杆菌（NTM）感染。宿主因素如活动性恶性肿瘤、免疫抑制、慢性阻塞性肺疾病（COPD）和支气管扩张会增加MAC感染的风险。然而，先前接受过治疗的肺癌患者随后发生MAC肺部疾病及其治疗结果之间的关系此前尚未得到研究。
我们回顾性地确定了2005年1月至2016年10月在梅奥诊所医疗记录中有记录的所有肺癌合并MAC肺部疾病的患者。在肺癌诊断之前或之时被诊断为MAC肺部疾病的患者被排除。符合所有纳入标准的患者接受了关于先前肿瘤治疗、临床特征和MAC治疗反应的病历审查。
我们确定了13例有MAC肺部疾病且先前患有肺癌的患者，其中包括4名男性和9名女性。8例患者有易患MAC肺部疾病的结构性肺病，包括支气管扩张（23.0%）和COPD（46.2%）。4例（30.8%）患者没有明显的免疫抑制或其他MAC肺部疾病的危险因素。原发性肺部恶性肿瘤包括肺类癌、腺癌和鳞状细胞癌。10例（76.9%）患者开始接受MAC抗菌治疗，8例（61.5%）患者完成了MAC治疗，6例（46.1%）患者症状得到改善。
先前接受过治疗的肺癌患者发生MAC肺部疾病时可能没有明显的这种NTM感染危险因素。MAC抗菌治疗后的症状改善似乎低于预期，但合并症可能会影响该患者群体的治疗结果。
